NPIMap

Organization Active NPI

Autumn Corporation

  • Nursing Facility/Intermediate Care Facility
  • Statesville, NC
National Provider Identifier
1891966156
Registry record updated Mar 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
NH0599 Issued in NC
Legal business name
AUTUMN CORPORATION
Practice address
2001 Van Haven Dr
Statesville, NC 28625-4342
Phone
(704) 883-9700
Fax
(704) 883-9966
NPI assigned
Mar 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Sam M Marsh, CPA
Title
Vice President of Finance
Phone
(252) 443-6265

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NH0599 NC Primary

Addresses

Primary practice location

2001 Van Haven Dr
Statesville, NC 28625-4342

Mailing address

2001 Van Haven Dr
Statesville, NC 28625-4342
Phone (704) 883-9700

Other identifiers 1

IdentifierTypeStateIssuer
340613PMedicaidNC

Other names 1

  • Autumn Care of Statesville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Autumn Corporation39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205452800000",
    "number": "1891966156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 VAN HAVEN DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254342",
            "telephone_number": "704-883-9700",
            "fax_number": "704-883-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VAN HAVEN DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254342",
            "telephone_number": "704-883-9700",
            "fax_number": "704-883-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-14",
        "last_updated": "2008-03-14",
        "status": "A",
        "authorized_official_last_name": "MARSH",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "252-443-6265",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NC",
            "license": "NH0599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340613P",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Care of Statesville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.